Journal of Human Lactation最新文献

The World Health Organization recommends exclusive breastfeeding for the first six months of life and continued breastfeeding for up to two years. A mother's ability to initiate and sustain breastfeeding is shaped by complex individual- and community-level attitudes, beliefs, and knowledge, making it challenging to measure these factors across diverse contexts. This paper presents a comprehensive overview of existing instruments that assess breastfeeding attitudes, beliefs, and knowledge to facilitate the selection of appropriate tools, building upon existing reviews that have examined validated instruments for attitudes, knowledge, self-efficacy, and social support. This review aims to support researchers, program designers, and policymakers in choosing tools that align with their specific objectives, populations, and theoretical frameworks. A curated selection of validated instruments is presented in table format, highlighting constructs such as self-efficacy, attitudes, and beliefs. These tools were selected based on their relevance to general maternal populations, use in peer-reviewed research, and applicability across the breastfeeding continuum. Key domains included in the table are the construct measured, item format and scoring, considerations for tool selection, and examples of translation and cultural adaptation. Included instruments are psychometrically robust with established validity and reliability, and many have been adapted for and tested in diverse cultural settings. The table reveals that while many instruments demonstrate strong reliability and validity, their scope, cultural adaptability, and focus across the breastfeeding timeline vary considerably.

Background: Breastfeeding is strongly promoted by health authorities, but there is little research on whether health professionals provide best-practice care for women experiencing mastitis/breast abscess.

Research aim: To explore management of mastitis/breast abscess in hospital emergency departments (EDs).

Methods: Medical records of patients presented to hospital EDs in Australia, Brazil, Croatia, Germany and Türkiye with lactational mastitis/abscess between 2017 and 2023 were reviewed. Demographic and clinical information (including symptoms, management, and investigations) was extracted and analyzed.

Results: A total of 580 women with mastitis/breast abscess (646 Emergency Department presentations, mostly in the first 8 weeks postpartum) were identified during the study period. The majority of the women had symptoms of mastitis/breast abscess (breast pain, lump, and inflammation) for > 48 hours before presenting in the Emergency Department. In Australia, culture and sensitivity testing of milk was available for 44% (146/331) of presentations. S. aureus was the most common bacteria isolated (33%, n = 48), of which 6% (n = 3) were methicillin-resistant. The use of diagnostic ultrasound varied between sites, from 5% (3/65) in Croatia to 82% (40/49) in Germany. Breast abscesses were mostly managed by ultrasound-guided aspiration in Australia, whereas incision and drainage was standard care in Germany. Amoxicillin/clavulanate was most commonly prescribed in Croatia (57%, 31/54) and Türkiye (69%, 28/42), whereas flucloxacillin, cephalexin, or cefuroxime was primarily used in Australia (86%, 272/322), Brazil (62%, 66/106), or Germany (80%, 33/41), respectively.

Conclusions: The management of mastitis/breast abscess varied considerably between countries. International evidence-based guidelines for the management of lactational mastitis are urgently needed.

Background: Breastfeeding, widely recognized for its significant health benefits, presents multifaceted challenges that contribute to low breastfeeding rates in many countries worldwide. In postmodern society, women's decisions regarding breastfeeding are influenced by numerous factors, including socioeconomic status, work-related demands, social norms, digital media, and individual subjectivities.

Research aim: This study aims to identify and analyze the subjective factors that shape women's perceptions of breastfeeding in low-income settings, including the impact of breastfeeding discourse.

Methods: The research employed a qualitative approach, utilizing Cartography for data collection and Laurence Bardin's Content Analysis for interpretation. Nineteen postpartum women from a public hospital participated in the study, sharing their emotions, perceptions, and objective factors influencing their breastfeeding decisions.

Results: A complex interplay of positive and negative sentiments was observed. Bonding, defined as a feeling of connection to the baby, emerged as the most prominent positive emotion. On the other hand, fear and insecurity-primarily related to concerns about pain and insufficient milk supply-were identified as the dominant negative emotions. Additionally, participants expressed embarrassment about breastfeeding in public and emphasized the crucial role of information and support provided by healthcare professionals.

Conclusion: Understanding the subjective factors influencing breastfeeding choices among underprivileged women is essential for providing effective information and support. Reframing the breastfeeding discourse to reinforce women's confidence in their abilities, and emphasizing the societal responsibility for support, can help ensure a positive experience for all women and contribute to higher breastfeeding rates.

Background: When organizations are certified through the Baby-Friendly Hospital Initiative, health care providers implement various policies that are intended to support long-term and exclusive breastfeeding. Despite the availability of evidence to support these policies, research findings are inconsistent in whether these goals are met. Exploring cultural interpretations through the lens of individuals within these organizations may reveal new evidence of breastfeeding experiences and needed support.

Research aim: To explore organizational cultural aspects of a Baby-Friendly certified organization from the perspective of patients and employees.

Method: Researchers implemented a focused ethnography design in one certified organization in Ontario, Canada. One-to-one, semi-structured interviews were performed with two participant groups, including 10 patients and eight employees within intrapartum and postpartum care areas between 2023-2024. An inductive data analysis approach followed Roper and Shapira's framework, including (1) coding for descriptive labels, (2) sorting for patterns, (3) identification of outliers, (4) generalizing with constructs and theories, and (5) memoing.

Results: Five core themes emerged from the data, including (1) knowledge is power, (2) community of support, (3) contextual considerations, (4) environment for breastfeeding, and (5) patient factors. Through narrative descriptions, these interrelated themes exhibit how patients and employees have experienced or provided care that is consistent with breastfeeding-supportive policies as well as additional gaps that may not be addressed through policy research.

Conclusion: The results provide implications for breastfeeding support within an organization certified through the Baby-Friendly Hospital Initiative. Understanding cultural interpretations of breastfeeding can provide information for future education and interprofessional development.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a procedure utilized by speech language pathologists to evaluate swallowing function in infants and children. FEES has been found to be a valid and reliable procedure for the assessment of pediatric dysphagia. It is the only option for instrumental examination of swallowing in breastfeeding infants. This article describes the differences between the more common videofluoroscopic swallow study (VFSS) and FEES, as well as management of interprofessional collaboration.

Background: Breastfeeding is crucial for infant health, but nipple trauma remains a common challenge. In particular, nipple trauma can lead to the onset of mastitis and psychological distress for mothers. Silver nipple protectors have been suggested to alleviate this issue, but detailed research is needed.

Research aim: This study aims to clarify the effectiveness of silver nipple protectors in treating nipple trauma in Japanese women.

Methods: A non-randomized comparative trial compared 47 participants (94 nipples) using silver nipple protectors with a control group of 50 participants (100 nipples) from historical data. The assessment included chronological changes in nipple condition, level of nipple pain, and safety, among other factors. Data collection spanned from 2023 to 2024.

Results: The group using silver protectors experienced fewer instances of severe nipple trauma and showed a higher frequency of healing patterns. Many of these patterns involved a transition from mild erythema or swelling toward a healing state. Specifically, the level of nipple pain on the 4th postpartum day was significantly lower. No safety issues from the use of silver protectors were noted.

Conclusion: This study suggests that silver nipple protectors may prevent the occurrence of severe nipple trauma and are safe and beneficial for Japanese women. Future research should focus on the mechanism of silver protectors, their long-term effects, regional differences, practical challenges for implementation, and comparisons with other common treatments.

Background: Human milk and colostrum have been well studied; however, limited data are available on the variations in macronutrient content when compared across different infant weight categories for infants with similar gestational ages.

Research aims: To compare the colostrum macronutrient content of participants who delivered term infants classified as small for gestational age, appropriate for gestational age, and large for gestational age.

Methods: In this exploratory cross-sectional observational study (N = 252), colostrum (on postpartum Day 2) was collected and categorized by gestational weight group. The protein, fat, carbohydrate, and energy levels of colostrum were measured using a mid-infrared human milk analyzer. Values were dichotomized at the median and compared using logistic regression.

Results: Median colostrum protein content was significantly higher in the small for gestational age (4.8 [IQR = 3-6.4] gr/dl) and large for gestational age (4.4 [IQR = 3.5-5.3] g/dl) groups compared to the appropriate for gestational age group (2.8 [IQR = 2.1-3.7] g/dl; p < 0.001). Median carbohydrate content was significantly higher in the large for gestational age group (5.3 [IQR = 4.2-6] g/dl) than appropriate for gestational age group (4.5 [IQR = 3.5-5.3] g/dl; p = 0.002). In multivariate analysis, being SGA or LGA was independently associated with higher milk protein content (OR 4.68; 95% CI [2.25, 9.77; p < 0.001; and OR 6.76; 95% CI [3.30, 13.87]; p < 0.001, respectively). Only being LGA was associated with higher carbohydrate content (OR 2.74; 95% CI [1.46, 5.16]; p = 0.002).

Conclusion: Colostrum macronutrient content varies depending on whether the birthweight is small or large for gestational age. Studies are needed to investigate these potential associations and the clinical consequences of this relationship.

Background: Human milk-feeding benefits infants and parents. Exclusive human milk (EHM) feeding is recommended for infants younger than 6 months; however, many U.S. infants do not receive this recommendation. Documented disparities exist between White and historically marginalized populations, including Hispanic/Latino parents.Quality Improvement Needs Assessment Aims:To explore Hispanic birthing parents' experiences with human milk-feeding and lactation support as part of a quality improvement needs assessment project, identifying barriers and facilitators during post-birth hospital recovery.

Methods: We collected and triangulated three data sources for 37 interviews: (1) in-hospital observations that included opportunistic informal interviews, as well as telephone interviews with (2) English- and Spanish-language-preferring Hispanic birthing parents, and (3) pediatric clinician interviews (via snowball sampling recruitment). In-hospital observations were collected in March 2022 at a Northern California academic medical center. Interviews included birthing parents, physicians, nurses, clinical trainees, administrators, and lactation consultants. Telephone interviews occurred between March and May 2022. We used rapid and thematic analysis, subsequently mapping themes to the socioecological model as an organizing framework.

Results: Interpersonal growth opportunities were identified: trust-building through deep listening, better communication between patients and clinicians, particularly at night, and better cross-language understanding. At the hospital level, identified needs included supportive maternity care practices, lactation staff availability, and more perinatal lactation education and resources (e.g., iPads, pumps). Spanish-language-preferring patients reported needing better interpretation services.

Conclusion: This quality improvement project identified opportunities for improvement in relationships with patients, clinician communication, and training and physical resources.